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室性心律失常的导管消融
Catheter Ablation of Ventricular Arrhythmias


Kalyanam Shivkumar ... 心脑血管疾病 • 2019.04.18
相关阅读
• 室性心律失常治疗和心脏性猝死预防:指南更新 • 肿瘤学技术应用于室性心律失常的消融 • 放射消融治疗室性心动过速:下一个前沿

室性心动过速是由心室心肌的异常放电病灶或环路引起,通常表现为快速性心律失常和心电图(ECG)上的宽QRS波群,伴有或不伴有从头晕至晕厥或心脏性猝死等临床后果。室性心动过速的治疗需要评估心律失常引起的猝死风险,评估是否患基础心脏病及其严重程度,并且权衡现有治疗的风险和益处。

在结构性心脏病患者中,室性心动过速与心脏性猝死风险增加相关1,2。植入式心律转复除颤器(ICD)已成为预防这些患者猝死的既定手段1,2。然而,ICD不能预防室性心动过速。当室性心动过速的负荷高,导致多次ICD电击或抗心动过速起搏时,需要采取其他治疗。使用ICD患者的室性心动过速治疗药物包括β受体阻滞剂和抗心律失常药,例如索他洛尔、美西律、多非利特和胺碘酮。

无结构性心脏病的室性心动过速患者发生猝死的风险低。药物治疗通常用于此类患者的症状管理,一线用药包括β受体阻滞剂和非二氢吡啶类钙通道阻滞剂1,2

以导管为基础的室性心动过速治疗方法受到外科研究的启发,外科研究表明,切除心肌瘢痕可控制室性心动过速3。1983年首次报告室性心动过速的导管消融治疗取得成功4。随着射频消融术在20世纪90年代的发展,近20年来室性心动过速导管消融治疗的使用有所增加5。当药物无效或有不可接受的副作用时,通常会考虑使用导管消融治疗室性心动过速6





作者信息

Kalyanam Shivkumar, M.D., Ph.D.
From the University of California, Los Angeles (UCLA), Cardiac Arrhythmia Center and Electrophysiology Programs, David Geffen School of Medicine at UCLA, Los Angeles. Address reprint requests to Dr. Shivkumar at the UCLA Cardiac Arrhythmia Center, 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA 90095, or at kshivkumar@mednet.ucla.edu.

 

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